Presumptive eligibility means that people are presumed eligible for Medicaid and can receive Medicaid services without going through the normal application process.

Under the HHS rule filed on July 5, hospitals will now be able to determine presumptive eligibility for Medicaid. States may establish state-specific standards for qualified hospitals for all potential Medicaid eligible populations, but no training for eligibility determination is required by the federal government.

Taxpayers are required to pay for the services provided even if the person is later proven not to have been eligible for Medicaid. States will not be permitted to recoup money from the hospital, and CMS will not recoup money from the state.

In 2004, the State of Colorado canceled a program under which medical clinics could determine presumptive eligibility for Medicaid prenatal care. A state audit showed that more than half of the 19,000 women who received care through the program in 2003 were ultimately determined to be ineligible. Almost a third of the women were illegal aliens. Almost a quarter were ineligible because they did not meet income restrictions. Before the audit, the clinics had assured the state Medicaid department that more than 90 percent of women that they said were presumptively eligible did in fact end up qualifying for Medicaid.

This is quite an indictment. But it is another piece of evidence that the argument for cost shifting (by providers to private payers to subsidize Medicaid’s underpayment), is inaccurate.

Pre-natal care is not emergency care, which hospitals must provide under EMTALA. Rather, these medical clinics sought out and enrolled Medicaid patients, suggesting that Medicaid reimbursement is profitable.

Wouldn’t hospitals have an incentive to allow people who wouldn’t be considered eligible by the common man, so they can make more money, and the Medicaid program will still be abused. The only thing that has changed is the culprit…

Maybe the key to improving hospitals’ accuracy is putting them on the hook for the cost should their eligibility assessment prove to be wrong (not the patient; nor the taxpayer). Under those conditions I bet the percentage of people incorrectly identified as Medicaid eligible would be much closer to being accurate.

Good God! So basically there will be no stewardship over the people’s (taxpayers) money whatsoever. Just give it away to whoever you feel like, no questions asked, no accountability expected. If it costs a lot, oh well — we’ll just add it to the deficit. Belize is looking better all the time.